Friday, August 07, 2009

So, I promised to write about health care and the first thing on my list was an examination of the main issues with our current system. This is my list and my view of things. Many people won’t share my concerns and, in some cases, there is no common ground. If you simply don’t believe that it is incumbent on us to try and find a way to provide health care to those that want and need it, regardless of their ability to pay, then we will have to agree to disagree.

Call me a socialist but I do believe that there is a role for society to ameliorate the most crass distortions and human costs of our economic system. I do not want to “destroy” capitalism. I enjoy the energy, innovation, vibrancy and variety that our semi-free markets provide us with. Still, I am under no illusion that ours is a truly free market and I’m glad that is the case. I am glad that the government requires pharmaceutical companies to adhere to standards of testing and manufacturing to ensure our safety. I’m glad that our slaughterhouses generally adhere to minimum standards for health and safety for their workers and even for the animals processed there. . . though clearly there’s a ways to go in that area. I’m glad that there are some constraints on the financial markets, however imperfect and fecklessly enforced they may be and I’m happy that contracts and transparency are regulated to some degree by law. In general, I see a role for our government in moderating our economic activity through both laws and institutions to enforce them and I’m certain most of my fellow Americans would agree. If you don’t, stop here. You’ll just cause your self unnecessary indigestion by reading further.

So, what are these issues confronting us in the health care system in the US? I list the following:

Access to health care regardless of ability to pay.

Access to health care regardless of the presence of pre-existing conditions.

Controlling the cost of health care while ensuring adequate standards.

Ensuring the freedom to choose your health care providers.

Ensuring the freedom to determine your treatment plan in consultation with your doctor without undue restriction.

Equitably sharing the costs of health care among all members of society.

Removing the stress from health care provision

Of course there are other issues and I’m certain many would disagree with my choices. I will make my arguments and you’re not only free to disagree, I hope you will make your own and post them in comments to this discussion.

After writing for a while on even this relatively straightforward subject, I found myself to so deep in the material and cranking out such a volume of words that I felt it best to break this into smaller chunks. This is as much for my benefit as for yours. There’s simply too much to go over to do it any justice in a quick entry and the length of the entry I was in the midst of writing was exhausting to read as well as write. So, one post per issue and one issue per day will be the order of things.

Let’s take them in the order I’ve listed them, though that’s not necessarily indicative of any real priority.

1) Access to health care regardless of the ability to pay.To me this is fundamental and encompasses much more than the issue of insuring the poor, though that alone is reason enough to consider this a critical issue. The argument I most often hear against ensuring everyone is that people must earn their keep and we shouldn’t support those amongst us who don’t work. Well, the reality is that the majority of those who don’t work at all already receive health care through the government’s medicaid program. This is the health care part of the welfare program. Whether or not you agree that this is a good thing, it is so and so it brings us to consider who we are talking about when we speak of the uninsured?

Here are the main categories of uninsured people in this country:

The working poor. This group of people earn too much to qualify for most assistance but not enough to pay for health insurance. Even those fortunate enough to work for an employer who offers health insurance often earn too little to participate in the plan or can only afford catastrophic coverage. Even more work part time or for companies that offer no such coverage and so are unable to purchase subsidized insurance. These people do work but still they are uninsured or massively underinsured.

Young people. I was once among those who didn’t have insurance because they believed themselves young and healthy and immortal. To be honest I had health insurance on and off but it was never a priority. I found out only later that I had a congenital condition that could easily have caused me to be hospitalized or worse. Accidents do happen and even young people should be a part of the insurance pool to ensure the necessary mix of healthy and sick people required for the system to work. We protect our own children against their occasional folly. Shouldn’t we do the same for our societies most precious resource?

The unemployed. No, this isn’t necessarily poor people and it’s not the working poor. It’s almost anyone who endures a long period or unemployment in this country. Even if we had insurance and have some reserves to pay the inordinate costs of COBRA to maintain it while unemployed, we can only do this for a certain period of time before it runs out or we run out of money. Right now, in this country, losing your job generally means losing your insurance. . . unless you’re wealthy, of course. Should that be the case? I don’t believe so.

The sick. What, you ask? How can it be that the sick are a “category” of people who are uninsured? Well, they aren’t, exactly. They make up a composite of other groups. Being ill in this country carries serious consequences that may include the loss of your job, home and health coverage! Yes, extended illness can see your income evaporate and the employer provided health insurance along with it. The debts you incur can cause you to lose everything you own, including your home and, with the money all gone, you will have no resources to pay for the health care you need. Yes, theoretically, you may then qualify for medicaid and receive health care, once again. Unfortunately, it is required that you be financially ruined before society will lend you a hand. You must go through that stress in addition to confronting your health condition. Only then, when it may be too late, do we have a “safety net.” It’s a bit like scraping the trapeze artist up off the floor after a fall.

So, should we provide coverage for these people? I think so. We have other priorities in this country that we fund and that I believe are not nearly as important or even critical to our long term security. More than that, I feel this is truly a moral issue. No one should be required to suffer the indignity and very real harm that the gaps in our system can cause.